Free flap surgery. The second decade.

After 2 decades of increasing expertise, microvascular free tissue transfer has gradually evolved from being a procedure of last resort to become a first choice reconstructive procedure. Improved success rates, reduced operative time, and patient morbidity have widened the indications for the procedure. This has profoundly affected our reconstructive principles and, in many instances, reversed some well-established dogmas of wound care, cancer resectability, and salvage of multilated parts. As the constraints of tissue survival decrease, more attention can be given to the artistry and functional restoration.